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Hostel Registration Form

The document is a Hostel Registration Form for Adamas University, requiring personal details, medical information, and local guardian details from students. It includes a declaration section where students and guardians must affirm the accuracy of the provided information and agree to abide by hostel rules. The form also outlines the consequences of providing false information and the university's rights regarding room assignments and fee adjustments.

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sarumandal027
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19 views4 pages

Hostel Registration Form

The document is a Hostel Registration Form for Adamas University, requiring personal details, medical information, and local guardian details from students. It includes a declaration section where students and guardians must affirm the accuracy of the provided information and agree to abide by hostel rules. The form also outlines the consequences of providing false information and the university's rights regarding room assignments and fee adjustments.

Uploaded by

sarumandal027
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Office Copy

Affix Recent
Passport Sized
Colour Photograph

ADAMAS UNIVERSITY
Barasat – Barrackpore Road, P.O. – Jagannathpur, PS Barasat
Dist. North 24 Parganas, Kolkata – 700126

HOSTEL REGISTRATION FORM

Programme : Branch /Specialization:

Registration No : Roll No: ______

Personal Details (All In Block Letters)

Student Details

Name :

Date of birth (mm/dd/yyyy) : / / Blood Group :

Mother Tongue : Religion :

Gender (M/F/Transgender) : Caste (SC/ST/OBC/General):

Communication address :

P.O. P.S. ________________________

City __________________________District ___________________

State _______Country ______ PIN ______

Permanent address :

P.O. P.S. ________________________

City __________________________District ___________________

State _______Country ______ PIN ______

Telephone / Mobile : E-mail ID: _____

For Students not being Resident of India


Country: Nationality:

Passport Number: Expiry Date:

Visa Type: Expiry Date:

Medical Information

Blood Group :

Name of Family Physician :

Contact No of Physician :

Regular Medicine Taken :

(if any)

Medical Condition which may require special attention:

Details of Local Guardian

Guardian’s Name :

Occupation : Relationship with Student:

Address :

P.O. P.S. ________________________

City __________________________District ___________________


State _______Country ______ PIN ______

Telephone / Mobile : E-mail ID:

For Office Use Only

Hostel Name :

Room Number : Room Type: AC / Non AC

Remarks :

Declaration by the Student and Parent / Guardian


We do hereby declare that the information furnished hereinabove are true to the best of our knowledge and
belief and we understand that if any of the information and/or document furnished by me / us is found to be
false and/or fabricated, allotment, if granted, is liable to be cancelled at the discretion of the University and I/we
shall not be entitled to refund of any fees and/or charges paid by me/us.
We hereby further declare that we have gone through the rules and regulations pertaining to Hostel and, if
allotment is granted, I/we undertake to abide by the same and I/we understand that in the event of violation the
student may be expelled from the Hostel.
We also understand that in the event of exigency the University reserves the right to change the Rooms allotted
at its own discretion and I/we shall not object to the same.
We are aware that Air Conditioners in AC rooms shall not be operational during class hours of the University
commencing from 1st day of March till the last day of October and the entire duration from November to
February, subject to weather conditions, and I/we agree to the same.
We understand that under extreme situations the Hostel fees may be revised at the discretion of the University
and I/we agree to pay the revised fees without any objection.
We further declare and undertake that the student shall not participate in any move to create group / class
feeling amongst the students. We are aware of the rules regarding ragging / harassment of juniors and/or other
students of the University as well as the punishments thereof. We do hereby also declare that I/we shall
cooperate with the authorities in curbing ragging (including reporting incidents of ragging), failing which
disciplinary action as per the applicable rules will be taken against the student.
We hereby undertake to intimidate the University if there is any change in contact details failing which the
University shall not be held liable in case of non-receipt of any communication/notice.

Date:

________________________________ _________________________
Full Signature of the Parent/Guardian Full signature of the Student

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